Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Steinman and colleagues1 found that broad-spectrum antibiotics are commonly
prescribed in the United States for the treatment of acute respiratory tract
infections (ARTIs), especially by internists and physicians in the Northeast
and the South. However, several confounding factors may bias the results toward
the overuse of broad-spectrum antibiotics. First, the authors did not report
failure rates after completion of a course of a first-line narrow-spectrum
agent, which would have resulted in treatment with a broad-spectrum agent.
Second, the authors did not assess other clinical aspects that may have warranted
appropriate use of a broad-spectrum antibiotic. For example, patients who
were previously treated for the same respiratory tract infection within the
past 6 months have been found to have a higher prevalence of resistant organisms.2 Smoking, which increases the likelihood or resistant
organisms, is also important.2 Finally,
the authors did not clearly identify the "predictors" of broad-spectrum antibiotic
prescribing for ARTI. With sinusitis, bronchitis, and otitis media accounting
for 75% of antibiotic prescriptions in the United States and with the most
common associated pathogens being Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis,3 appropriate
use of antibiotics and the clinical reasons for prescribing them are important.
Karnath BM, Luh JY. Variation in Use of Broad-Spectrum Antibiotics for Acute Respiratory Tract Infection—Reply. JAMA. 2003;289(21):2796–2798. doi:10.1001/jama.289.21.2796-a